Shaped by Global Drivers and Local Environments

This first in a series of Lancet articles on global obesity describes the epidemic, its rise concurrently across the globe, and wide variations in prevalence among countries. Unlike for other preventable causes of death and disability (tobacco use, hypertension), no country serves as an example for how to reverse obesity through public health measures.

The global rise in obesity follows predictable patterns—with small variations in ethnic preferences for body size. Groups with high socioeconomic status in urban areas are the first to have high obesity prevalence. As gross domestic product increases, the burden of obesity shifts to lower socioeconomic status and rural areas. While economic growth moves low-income countries out of poverty, it also leads to overconsumption of cheap food and obesity.

Interventions to reverse obesogenic drivers largely will be government policy-led, such as shifting agricultural policies to incorporate health outcomes, reducing the costs of healthy foods and increasing that of unhealthy ones. Policy interventions for obesity will necessarily be directed at the environment—using social marketing, health education and health promotion to make healthy choices easier for individuals.

In the four decades since global obesity began, governments have issued reports and formulated plans to combat obesity, but few have moved from rhetoric to action.